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Intra-individual comparison of dual portal venous phases for non-invasive diagnosis of hepatocellular carcinoma at gadoxetic acid–enhanced liver MRI

  • Gastrointestinal
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Abstract

Objectives

To compare the diagnostic performances of first and second portal venous phases (PVP1 and PVP2) in revealing washout and capsule appearance for non-invasive HCC diagnoses in gadoxetic acid–enhanced MRI (Gd-EOB-MRI).

Methods

This retrospective study included 123 at-risk patients with 160 hepatic observations (HCCs, n = 116; non-HCC malignancies, n = 18; benign, n = 26) showing arterial phase hyper-enhancement (APHE) ≥ 1 cm at Gd-EOB-MRI. The mean time intervals from gadoxetic acid injection to PVP1 and PVP2 acquisitions were 53 ± 2 s and 73 ± 3 s, respectively. After evaluating image findings independently, imaging findings and diagnoses were finalized by a consensus of two radiologists using either PVP1 or PVP2 image sets according to the LI-RADS v2018 or EASL criteria. Sensitivity, specificity, and accuracy were compared.

Results

Among HCCs, more washout and enhancing capsule were observed in PVP2 (83.6% and 27.6%) than in PVP1 (50.9% and 19.8%) (p < 0.001, both). The PVP2 set presented significantly higher sensitivity (83.6% vs. 53.5%, LI-RADS; 82.8% vs. 50.0%, EASL; p < 0.001, both) and accuracy (0.88 vs. 0.73, LI-RADS; 0.88 vs. 0.72, EASL; p < 0.001, both) than the PVP1 set without significant specificity loss (93.2% vs. 93.2%, by LI-RADS or EASL; p = 0.32, both). None of the non-HCC malignancy was non-invasively diagnosed as HCC in both PVP image sets.

Conclusion

Late acquisition of PVP detected washout and enhancing capsule of HCC more sensitively than early acquisition, enabling accurate diagnoses of HCC, according to LI-RADS or EASL criteria.

Key Points

• Among HCCs, more washout and enhancing capsules were observed in PVP2 than PVP1, quantitatively and qualitatively.

• The portal venous phase acquired at around 70 s after contrast media administration (PVP2) provided significantly higher sensitivity and AUC value than PVP1 by using LI-RADS v2018 or EASL criteria.

• More HCCs were categorized as LR-5 in PVP2 than in PVP1 images, and the specificity of PVP2 (93.5%) was comparable with PVP1 (93.5%).

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

AP:

Arterial phase

CC:

Cholangiocarcinoma

EASL:

European Association for the Study of the Liver

Gd-EOB-MRI:

Gadoxetic acid–enhanced magnetic resonance imaging

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

PVP:

Portal venous phase

SI:

Signal intensity

TP:

Transition phase

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Acknowledgments

We thank Kyoungbun Lee and Haeryoung Kim for their histologic assistant.

Funding

This research was supported by a grand from Bayer Korea (grant number: 06-2018-3790).

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    Hyo-Jin Kang, Jeong Min Lee, Sun Kyung Jeon, Sungeun Park, Ijin Joo, Jeong Hee Yoon & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea

    Hyo-Jin Kang, Jeong Min Lee, Sun Kyung Jeon, Sungeun Park, Ijin Joo, Jeong Hee Yoon & Joon Koo Han

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea

    Jeong Min Lee & Joon Koo Han

  4. Department of Radiology, Seoul National University Boramae Medical Center, Seoul, South Korea

    Siwon Jang

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Correspondence to Jeong Min Lee.

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Kang, HJ., Lee, J.M., Jeon, S.K. et al. Intra-individual comparison of dual portal venous phases for non-invasive diagnosis of hepatocellular carcinoma at gadoxetic acid–enhanced liver MRI. Eur Radiol 31, 824–833 (2021). https://doi.org/10.1007/s00330-020-07162-4

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